POS0472 TREATMENT RESPONSE TO INTRAMUSCULAR STEROIDS IN PATIENTS LIVING WITH RHEUMATOID ARTHRITIS: AN EXPLORATORY ANALYSIS USING TRACKED DAILY SYMPTOMS
Authors: M. Al-Attar, J. Gandrup, S. Van der Veer, W. Dixon
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Current understanding of treatment response is largely based on patient recollection at infrequent clinic appointments, which introduces inaccuracies through recall error. Real-time patient-reported symptom data collected frequently following an intervention could improve our understanding of treatment response, facilitating better clinical decision making. <h3>Objectives</h3> Our exploratory analysis reports a case-series of patients who used the Remote Monitoring of Rheumatoid Arthritis (REMORA) smartphone-app for daily symptom tracking, evaluating their longitudinal pain-scores following intramuscular (IM) steroids to determine the duration and extent of treatment response. <h3>Methods</h3> We identified patients participating in the REMORA study Nov 2021-Sep 2022 who received an IM steroid. Concomitant disease-modifying medications were noted. Daily pain scores (out of 10) from 10 days preceding the injection and 8 weeks following were analysed. Analysis was based on the following definitions: [1] Pre-injection pain score: mean pain-score in the 10 days preceding injection; [2] Response (Y/N): ≥1 day of pain score &lt;[1]; [3] Response start time: the day following injection; [4] End of response: first date following injection with pain score ≥[1]; [5] Response duration: number of days between [3] and [4]; [6] Average pain-score response: mean pain score during [5]; [7] Nadir pain score response: lowest pain score during [5]; [8] Average pain score improvement: difference between [1] and [6]; [9] Maximum pain score improvement: difference between [1] and [7]. <h3>Results</h3> Thirty-two patients were identified for inclusion, of whom 6 received ≥1 steroid injections. In total 9 injections were given. Pre-injection pain scores ranged 3.33-9.29. Seven injections demonstrated response, 2 did not. Of the responders, duration ranged 1-54 days (median 9 days); average pain score improvement ranged 0.14-5.33 (median 3.33); maximum pain score improvement ranged 0.14-7.00 (median 4.33). Table 1 summarises our results. Figure 1 demonstrates the patterns of treatment response for each steroid injection. <h3>Conclusion</h3> Smartphone-based remote monitoring has the potential to improve clinical care for people living with rheumatoid arthritis. In this analysis, we demonstrated a novel means to accurately assess treatment response using tracked symptom data. The duration and extent of response to steroid injections was quantified for all participants, data which is typically imprecise and relies on recall. In these preliminary results, response duration was shorter, and pain score improvement was smaller, than anticipated. Analysis of tracked symptom data across a larger population may help to identify treatment responder characteristics, supporting more targeted therapeutic strategies. This has significant implications for high-cost drugs such as biologics. Further work is required to develop consensus definitions for treatment response and disease activity in time-series data, and a means to account for the effects of concomitant drugs. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Mariam Al-Attar: None declared, Julie Gandrup Employee of: JG is currently employed by UCB. The work was completed before joining UCB., Sabine van der Veer: None declared, William Dixon: None declared.